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Insanity;  its  nature 

COLORADO  BULLETIN 

Vol.  xin.  No.  11 


Published  Monthly  by  the  Regents  of  the  University  of  Colorado. 
Entered  at  the  Post  Office,  Boulder,  Colorado,  as  second-class  mail  matter. 


INSANITY 
ITS  NATURE,  CAUSES  AND  PREVENTION 


Boulder.  Colorado.  November.  1913 


UNIVERSITY  EXTENSION  DIVISION 

General  Series  No.  12 
Hygiene  Series  No.  1 


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College  of  ^fjj'gicians!  anb  burgeons; 
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Digitized  by  the  Internet  Archive 

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http://www.archive.org/details/insanityitsnaturOOrama 


UNIVERSITY  OF  COLORADO  BULLETIN 

Vol.  XIII.  No.  11 


Published  Monthly  by  the  Regents  of  the  University  of  Colorado. 
E-itered  at  the  Post  Office,  Boulder,  Colorado,  as  second-class  mail  matter. 


INSANITY 
ITS  NATURE,  CAUSES  AND  PREVENTION 

BY 
FRANCIS  RAMALEY 

Professor  of  Biology 


Boulder,  Colorado,  November,  1913 


UNIVERSITY  EXTENSION  DIVISION 


General  Series  No.  12 
Hygiene  Series  No.  1 


Copyright,  1913, 

BY 

Francis  Ramaley. 


INTRODUCTION 


If  one  were  to  take  quite  seriously  the  warnings ,  of  popu- 
lar writers,  it  would  be  easy  to  become  convinced  that  the 
entire  American  people  is  quickly  tending  toward  insanity.  The 
large  number  of  patients  in  hospitals  for  the  insane  is  pointed 
out  as  proof  positive  that  mental  disease  is  rapidly  increasing. 
Indeed,  figures  from  all  communities  where  the  insane  are  given 
adequate  care,  show  that  governments  are  constantly  called  upon 
for  greater  and  greater  appropriations  for  hospital  maintenance. 
There  are,  however,  certain  reasons  for  this  condition  which 
are  not  fully  understood  by  the  average  citizen:  (1)  With  im- 
proved conditions  in  hospitals  there  is  less  objection  to  commit- 
ment than  formerly,  whether  from  patients  themselves  or  from 
relatives.  (2)  With  better  care,  patients  live  longer  than  when  they 
were  less  well  provided  for.  (3)  With  more  knowledge  of  insanity 
on  the  part  of  physicians,  cases  are  recognized  earlier  and  the 
victims  of  suicidal  mania  are  committed  before  they  reach  the 
stage  in  which  they  are  ready  to  accomplish  self-destruction.  (4) 
The  greater  proportionate  number  of  persons  residing  in  cities 
makes  it  increasingly  difficult  for  families  to  conceal  cases  of  in- 
sanity, as  was  formerly  much  done  in  country  districts. 

The  importance  of  mental  disease  as  a  sociological  factor  is 
very  great.  Withdrawal  of  large  numbers  of  persons  from  pro- 
ductive occupations  is  in  itself  bad  enough;  but  the  sufferings  of 
the  patients  themselves  and  the  worry  and  anxiety  to  their  fami- 
lies are  even  worse.  The  public  still  looks  upon  insanity  as  a 
disgrace  and  the  members  of  a  patient's  family  feel  this  condi- 
tion keenly. 

Insanity  is  not  always  incurable,  as  so  many  imagine.  Even 
with  inadequate  facilities  for  the  care  of  the  insane,  about  one- 
third  of  all  cases  in  the  best  hospitals  are  either  completely  cured, 
or  else  benefited  to  such  extent  that  the  patient  is  able  to  return  to 
his  family  and  become  partially  or  wholly  self-supporting.  And 
while  the  possibility  of  cure  cannot  be  held  out  to  all  the  insane 
much  is  now  known  concerning  prevention.  If  the  average  person 
knew  as  much  as  he  easily  might,  and  would  live  in  the  light  of 


4  UXIVERSITY  OF  COLORADO. 

that  knowledge,  insanity  would  soon  become  of  less  than  one-half 
its  present  importance. 

Many  people  im'agine  that  all  "lunatics'"  are  the  same — they 
are  "raving  maniacs,"  likely  at  any  and  all  times  to  kill  either 
themselves  or  their  keepers.  The  facts  are,  however,  quite  other- 
wise. Except  for  a  comparatively  small  number  of  violent  individ- 
uals, the  patients  in  modern  hospitals  are  permitted  to  attend  sim- 
ple entertainments  given  in  the  institution;  many  assist  in  the 
necessary  work  of  the  garden  and  farm,  dairy,  laundry  and  kitchen. 
In  some  state  hospitals  the  meals  are  served  in  large  dining  rooms 
and  there  is  little  difficulty  in  maintaining  good  order.  Indeed, 
the  inmates,  with  certain  exceptions,  are  likely  to  be  as  well  be- 
haved as  the  boys  of  an  average  boarding  school  or  academy. 

One  difficulty  that  the  public  experiences  in  understanding  about 
insane  people  results  from  the  fact  that  the  names  of  the  various 
mental  diseases  are  generally  unfamiliar.  To  the  lay  mind  such 
terms  as  schizophrenia,  paresis,  paranoia,  and  catatonia,  mean  lit- 
tle. They  have  such  a  technical  and  scientific  sound  that  most  peo- 
ple would  pass  by  a  magazine  article  in  which  they  were  noticed. 
In  the  present  article  technicalities  will  be  avoided;  stress  will  be 
laid  upon  the  importance  of  insanity  to  the  community  and  to  the 
individual,  and  particular  attention  will  be  called  to  methods  of 
prevention, 

THE  MYSTERY  OF  INSANITY 


The  behavior  of  the  insane  has  always  seemed  so  entirely  be- 
yond the  bounds  of  reason  that  the  supposition  naturally  came 
about  that  no  explanation  of  insane  conduct  could  be  made.  Re- 
cently, however,  it  has  been  shown  that  the  various  delusions  and 
hallucinations  are  definitely  related  to  previous  mental  experience. 
Sometimes  the  connection  is  very  clear,  as  when  a  man  who  has 
had  great  struggles  with  poverty,  on  becoming  insane,  imagines 
himself  immensely  rich.  Or  one  of  an  over-sensitive  nature,  after 
brooding  over  an  insult,  becomes  violent  and  wishes  to  kill  every- 
one about  him.  In  this  latter  case  he  has  the  idea  of  revenge,  but 
is  ready  to  injure  those  who  never  brought  him  any  harm.  The 
self-accusations  of  some  of  the  mentally  unbalanced  no  doubt  arise 
through  the  magnification  in  their  own  minds  of  some  slight  fault, 


EXTEXSIOX  BULLETIX.  5 

perhaps  of  long  ago — even  back  in  early  childhood.  In  any  case 
of  insanity,  there  is  some  reason  for  the  symptoms  which  appear; 
although  without  more  information  than  is  usually  at  hand,  there 
is  necessarily  much  of  mystery  involved. 

Mental  disease  is  of  slow  development.  Onlookers  see  a  sud- 
den otitbreak,  btit  the  patient  himself  probably  knew  weeks  or 
even  months  before  that  he  was  ""'not  himself. '"  In  many  cases 
the  origin  of  an  attack  is  fotmd  in  some  infection  dating  back  ten 
or  twenty  years.  If  the  early  manifestations  of  mental  breakdown 
affect  only  the  individual  himself,  it  may  be  a  long  time  before 
even  his  friends  and  family  suspect  any  trouble.  This  is  especially 
true  with  those  of  a  reticent  disposition,  who  may  not  be  in  the 
habit  of  exposing  their  inmost  thoughts  to  others.  A  man  might 
imagine  himself  to  be  the  lawful  heir  to  the  British  throne,  yet 
if  he  told  no  one  about  it  and  contintied  in  his  regular  occtipa- 
tion  he  wotild  pass  as  a  normal  person.  If.  however,  he  should 
attempt  to  assassinate  the  king,  his  madness  would  be  at  once 
apparent.  Much  of  the  mystery  of  insanity  restilts  from  the  long 
period  dtiring  which  the  disease  makes  insiduotis  progress,  but  in 
which  there  are  no  visible  signs  of  mental  alienation. 


MANIFESTATIONS  OF  MENTAL  DISEASE 


Many  of  the  pectiliarities  of  the  insane  are  but  exaggeration 
of  characteristics  seen  in  ordinary  people.  The  common  manifesta- 
tions are:  excitement,  depression,  apathy,  obsessions,  delusions,  hal- 
lucinations. 

Excitement  is  well  enough  known  to  all.  Some  people  are  in 
a  constant  state  of  excitement.  Trivial  incidents  affect  them 
greatly.  The  mentally  tmbalanced  often  show  this  same  symptom: 
they  talk  incessantly,  go  rapidly  from  one  thing  to  another:  are 
now  in  the  seventh  heaven  of  bliss  and  again  in  the  depths  of 
despair.  States  of  depression  are  likely  to  alternate  with  periods  of 
excitement,  as  in  the  very  common  "maniac-depressive  insanity." 

Just  as  some  people  not  in  asylums  take  little  interest  in  their 
surroundings,  so  with  many  insane  patients.  This  condition  of 
apathy  may  become  so  pronounced  as  to  result  in  what  appears  to 
be  true  dementia  (loss  of  mental  power),  but  sometimes  the  apa- 
thetic  condition   disappears  and  the   patient   is   once   mere  able   to 


6  UNIVERSITY  OF  COLORADO. 

carry  on  ordinary  mental  processes.  True  dementia  is  incurable 
and  as  a  rule  becomes  progressively  worse  and  worse. 

Obsessions  show  themselves  in  impulses  which  the  person  may 
know  to  be  foolish  or  wrong,  but  which  it  is  well-nigh  impossible 
to  withstand.  Many  crimes  are  committed  under  the  compelling 
influence  of  an  obsession.  The  person  knows  he  is  doing  wrong, 
but  cannot  help  it.  Other  obsessions  lead  only  to  absurd  and  fan- 
tastic actions  such  as  washing  the  hands  a  hundred  times  a  day,  exam- 
ining the  number  of  every  bank  note,  looking  a  dozen  times  to  see 
whether  the  door  is  locked  or  the  clock  wound. 

Delusions  and  hallucinations  are  the  true  marks  of  insanity. 
The  former  are  false  ideas,  the  latter  false  sense  impressions. 
One  who  feels  that  he  is  the  pope  or  a  king  or  a  millionaire,  when 
this  is  not  a  fact,  is  the  victim  of  a  delusion.  The  seeing  of  snakes 
or  dogs  or  the  hearing  of  voices  which  have  no  existence,  the  smell- 
ing of  certain  odors  which  no  one  else  can  detect — these  are 
classed  as  hallucinations.  No  doubt,  delusions  and  hallucinations 
may  not  be  known  for  some  time  even  to  the  family  and  friends 
of  the  patient,  yet  sooner  or  later  they  are  likely  to  lead  to  abnor- 
mal conduct.  The  person  is  considered  insane  when  his  acts  be- 
come anti-social,  i.  e.,  inconsistent  with  the  social  conditions  under 
which  he  lives.  Arrogance,  conceit,  melancholy,  excitement  or 
apathy  may  be  unpleasant  to  other  members  of  the  family,  but 
these  characteristics  are  not  entirely  unbearable,  as  are  homicidal 
or  suicidal  mania,  destructiveness,  filthy  personal  habits,  or  acts 
which  bring  ridicule  upon  the  patient  or  his  family.  These  soon 
lead  to  legal  proceedings  for  the  commitment  of  the  offender. 

THE  NUMBER  OF  INSANE 


In  Colorado  the  state  hospital  for  the  insane  has  a  greater 
enrollment  than  the  state  university  and  a  like  condition  exists 
wherever  there  is  adequate  provision  for  the  insane.  Following  are 
the  number  of  insane  in  institutions  in  a  few  representative  states: 
Pennsylvania  16,992;  California  7,904;  Michigan  6,082;  Indiana  5,- 
378;  Minnesota  5,329.  The  foregoing  figures  are  taken  from  the 
latest  available  reports.  It  is  probable  that  the  total  number  of 
insane  for  the  United  States  is  greater  than  the  attendance  in  all 
the  universities   and  colleges  of  the  country. 


EXTENSION  BULLETIN.  7 

The  claim  has  heen  made  that  immigration  of  undesirable 
Europeans  is  responsible  for  much  insanity,  and  it  is  true  that 
the  proportion  of  insane  among  the  foreign-born  is  very  high.  It 
must,  however,  be  kept  in  mind  that  insanity  strikes  most  fre- 
quently in  the  age  period  from  twenty  to  thirty  and  that  young 
men  and  young  women  make  up  a  large  part  of  the  immigrant  ar- 
rivals each  year.  Statistics  show  the  frequency  of  insanity  to  be 
nearly  twice  as  great  among  the  foreign-born  as  among  natives,  but 
it  is  not  likely  that  this  is  the  true  proportion  for  corresponding 
ages.  We  are  so  accustomed  to  blame  the  poor  foreigner  for  his 
shortcomings,  that  there  is  danger  of  being  too  severe  with  him 
in  this   instance. 

Estimates  of  experienced  alienists  place  the  number  of  the  in- 
sane at  about  four  to  each  1,000  of  the  population.  This  number 
is  about  equalled  by  the  epileptics,  who.  let  it  be  understood,  should 
not  be  classed  with  the  insane.  Idiots,  imbeciles,  and  other  feeble- 
minded persons  are  much  more  numerous  than  the  insane.  Care- 
ful tests  of  children  of  school  age  suggest  that  about  two  per  cent, 
(twenty  to  the  thousand)  of  most  populations  are  distinctly  feeble- 
minded. Up  to  the  present  these  mental  defectives  have  not  re- 
ceived proper  state  care  and  every  institution  for  the  feeble-minded 
has  a  long  waiting  list.  There  is  great  need  for  better  provision 
for  these  unfortunates,  especially  the  segregation  of  all  feeble-minded 
women  of  child-bearing  age.  It  is  well  here  to  point  out  that  feeble- 
mindedness is  chiefly  hereditary  and  incurable.  The  condition  de- 
pends upon  original  lack  of  mental  capacity;  insanity,  on  the  other 
hand,  appears  in  those  who  were  at  one  time  normal,  but  who  later 
developed   aberrant  mental  processes. 

Hospitals  for  the  insane  usually  have  a  larger  number  of  men 
than  women  patients.  This  is  partly  due  to  the  greater  amount 
of  alcoholism  among  men,  so  that  probably  a  somewhat  greater 
number  of  men  than  women  become  insane.  Another  reason  for 
the  presence  of  more  men  patients  is  that  "queerness"'  in  a  man 
soon  Incapacitates  him  for  employment  while  a  woman  at  home 
may  be  quite  irrational  and  yet  not  unbearable  to  the  other  mem- 
bers of  her  familv. 


8  UNIVERSITY  OF  COLORADO. 

SOCIOLOGICAL  IMPORT  OF  INSANITY 

Like  any  other  illness,  insanity  .contributes  to  poverty;  it  is 
often  connected  with  crimes  of  violence;  it  has  much  to  do  with 
the  fantastic  political  and  religious  "movements"  of  every  age.  The 
contributions  of  the  mildly  insane  to  literature  and  the  other  fine 
arts  are  well  known. 

In  these  days  of  cash  estimates  perhaps  the  cost  of  caring  for 
the  insane  will  be  of  interest.  It  is  impossible  to  learn  of  the  ex- 
pense to  individuals  and  families,  to  counties  and  cities,  but  the 
maintenance  of  state  institutions  requires  large  sums  of  money.  In 
New  York  over  twenty  per  cent,  of  the  revenues  of  the  common- 
wealth go  to  the  support  of  the  insane.  No  doubt  this  is  a  pro- 
portion which  should  also  be  maintained  elsewhere.  In  every 
state  where  the  insane  are  well  cared  for  at  least  one-fifth  of  the 
revenues  will  probably  need  to  be  spent  on  their  care. 

But  this  enormous  expense  is  to  a  large  degree  unnecessary, 
or  would  be  unnecessary  if  measures  of  prevention  were  thoroughly 
understood  and  employed  by  the  individual  and  the  state.  This 
topic  will  be  given  consideration  later.  Suffice  it  to  say  at  this 
point  that  investigation  under  state  aid  is  much  needed.  The  real 
causes  of  insanity  should  be  thoroughly  studied  and  more  and  bet- 
ter  methods   of   prevention   developed. 

HEREDITY  IN  RELATION  TO  INSANITY 


There  is  a  common  belief  that  heredity  is  a  true  cause  of  insan- 
ity. Nearly  all  hospitals,  in  stating  the  causes  of  disease  in  their 
patients  list  from  twenty  to  thirty  per  cent,  as  hereditary.  A  part 
of  the  victims  of  "hereditary  insanity"  are,  however,  epileptics  and 
imbeciles.  With  the  true  insane,  family  "taint"  is  likely  to  show 
itself  in  a  "predisposition,"  and  mental  disease  may  "run  in  fam- 
ilies" just  as  tuberculosis  does.  But  with  tuberculosis  there  must 
be  other  factors  than  heredity  to  bring  on  disease,  so  also  with 
insanity.  What  is  inherited  is  not  the  insanity  itself,  but  rather  an 
unstable    mental   constitution. 

Instability  of  mental  make-up,  or  psychopathic  constitution, 
acts  in  inheritance  as   a  so-called  "negative  character."     It  seems 


EXTEXSIOX  BULLETIX.  9 

to   result   from   the   lack   of   something^  in   the    person    (perhaps    a 
chemical  substance),  something  which  normal  individuals  possess.* 
The  following  are  the  rules  of  heredity  as   applied  to  the  in- 
heritance of  mental  instability. 

1.  Two  normal  parents  coming  from  normal  families  will  have 
only  normal  children. 

2.  A  normal  person  of  a  perfectly  stable  family  married  to  a  per- 
son mentally  unstable  will  have  children  all  apparently  normal, 
but  really  with  a  hidden  "defect"  or  "taint"  which  may  appear 
in  a  later  generation. 

3.  Two  mentally  abnormal  parents  cannot  have  normal  children. 
If  the  parents  are  insane,  all  the  children  are  likely  to  be  men- 
tally unstable  and  may  "go  insane." 

4.  Two  apparently  normal  but  really  "tainted"  parents  may  have 
one  child  in  four  abnormal. 

5.  An  apparently  normal  but  really  "tainted"  person  mated  to  a 
mentally  unstable  person  will  have  one-half  the  children  nor- 
mal,  the  other  half  unstable. 

Certain  exceptions  may  occur  in  the  cases  enumerated  above, 
but  for  the  most  part  these  rules  apply.  The  conditions  may  be 
shown,  perhaps  more  clearly,  by  means  of  diagrams. 


Parents: 


Case   1 

Normal,  of  Normal,   of 

norm-al  X  normal 

family  family 


Children:         All  normal 

Case   2 
Parents: 

Normal,  of  Mentally 

normal  X  unstable 

family 

Children:         All  apparently  normal  but  really  with  a  hid- 
den "defect"' 


*  For  discussion  of  positive  and  negative  characters  the  reader  is 
referred  to  Charles  B.  Davexport's  "Heredity  in  Relation  to  Eugenics" 
(New  Yorlv.  1911),  pp.  16-21.  A  special  account  of  insanity  appears  in 
pages   77-SO. 


10 


UNIVERSITY  OF  COLORADO. 


Parents: 


Children : 


Parents : 


Children: 


Parents: 


Children: 


Case  3 

Mentally 
unstable  X 

All  mentally  unstable 

Case  4 


Mentally 
unstable 


Apparently  normal 


Apparently  normal 


but  really  with 
hidden  defect 

ormal;    ^ 
unstable 


X 


but  really  with 
hidden   defect 

like  the  parents;    14  Mentally 


Case  5 

Apparently  normal 
but  really  with  X 

hidden  defect 

1/^  like  one  parent;    i/^ 


Mentally 
unstable 
person 

like  the  other  parent 


Unstable  mental  make-up  is,  without  doubt,  transmitted  in  the 
way  indicated  in  the  diagrams  just  given.  One  who  comes  into  the 
world  with  such  a  constitution  is  unfortunate,  but  is  not  necessarily 
doomed  to  the  lunatic  asylum.  Perhaps  in  some  few  cases  a  bad 
heredity  cannot  be  counteracted  even  by  the  best  hygienic  condi- 
tions. This  is,  however,  not  really  known  with  certainty.  In  con- 
stitutional psycopaths,  head  injuries,  infectious  diseases,  under- 
nutrition, or  perhaps  even  psychic  traumata  (mental  or  emotional 
shocks)  may  bring  on  mental  disease,  but  if  these  can  be  escaped, 
insanity  can  probably  also  be  escaped  in  most  instances. 


CAUSES  OF  INSANITY 


Insanity  may  result  from  the  abuse  of  alcohol  or  other  poi- 
sons. Many  cases  appear  in  persons  with  an  early  infection  of 
syphilis;  sometimes  from  an  infection  that  dates  back  as  much  as 
ten  or  twenty  years.-  Both  of  these  causes  seem  to  be  purely  ex- 
trinsic, and  it  is  not  known  that  any  constitutional  peculiarity  is 
originally   present   in   those   who   develop   insanity   in   these   ways. 


EXTEXSIOX  BULLETIN.  11 

About  twenty  per  cent,  of  insanities  seem  directly  related  to  intem- 
perance and  about  ten  per  cent,  to  disease  resulting  from  immorality. 

Injuries  to  the  brain  bring  on  insanity  at  times,  but  not  every 
person  receiving  a  brain  injury  becomes  insane.  Mucb,  no  doubt, 
depends  upon  natural  mental  make-up,  something  upon  previous 
state  of  health  both  bodily  and  mental. 

Infectious  diseases,  lead  poisoning,  pellagra,  arteriosclerosis, 
child-birth  and  other  influences  tending  to  reduce  general  vitality 
may  be  classed  as  contributing  factors  in  many  insanities,  yet  it 
is  doubtful  if  any  one  of  these  is  the  sole  element  in  the  causation 
of  any  particular  case.  It  seems  likely  that  most  cases  of  insanity 
develop  very  slowly.  The  integrity  of  the  mental  mechanism  is  not 
easily  nor  quickly  destroyed.  There  must  have  been  something 
wrong  before  this  so-called  "cause"  appeared.  Perhaps  there  was 
some  faulty  construction  of  the  brain,  or  possibly  only  a  functional 
mental  disorder  of  long  standing.  These  questions  are  not  fully 
understood,  and  students  of  insanity  are  not  agreed  as  to  the  im- 
portance of  various  assigned   "causes." 

In  considering  the  so-called  "mental"  and  "moral"  causes  of 
insanity  much  the  same  comment  may  be  made  as  with  reference 
to  physical  diseases  and  injuries.  A  man  may  "go  insane"  follow- 
ing business  reverses,  or  domestic  difficulty,  or  the  death  of  wife 
or  child.  Yet  these  calamities  befall  thousands  of  other  men,  and 
they  do  not  lose  their  minds.  One  can  hardly  escape  the  convic- 
tion that  here  too  the  "causes"  are  but  contributing  factors.  The 
original  cause  must  be  something  far  more  deep-seated. 

A  theory  which  has  many  adherents  is  that  much  insanity  re- 
sults from  an  "auto-intoxication,"  that  is,  a  self-poisoning  due  to 
failure  of  the  body  organs  to  eliminate  promptly  the  poisons  which 
develop  in  the  ordinary  course  of  body  activity.  Many  patients 
give  a  history  of  long-continued  constipation;  some  have  kidney 
disorders;  with  many  there  are  recurrent  headaches  which  have 
caused  trouble  for  years.  These  various  symptoms  certainly  sug- 
gest some  kind  of  bodily  derangement. 

Certain  kinds  of  insanity  seem  associated  with  particular  men- 
tal dispositions.  There  are  people  with  the  "shut-in-personality," 
others  of  a  gloomy  cr  a  fault-finding  disposition,  still  others  char- 
acterized by  conceit  and  suspicion.  Each  of  these  three  types  of 
persons  contributes  largely  to  a  particular  corresponding  form  of 
insanity.     It   may   be   that   the   person   who   falls   into   bad   mental 


12  UXIVERSITY  OF  COLORADO. 

habits  thus  predisposes  himself  to  mental  alienation,  or  perhaps 
these  habits  are  merely  expressions  of  an  underlying  defect  which 
later  shows  itself  in  true  insanity.  Whichever  is  the  real  state  of 
affairs  it  behooves  all  those  who  are  "queer"  or  "peculiar"  to  at- 
tempt as  best  they  can  to  get  into  right  habits  of  thought  and  be- 
come like  other  people. 

To  sum  up  briefly  the  causes  of  insanity  is  difficult.  The  vari- 
ous students  of  the  subject  do  not  agree.  Yet,  in  spite  of  conflicting 
views,  the  following  statements  may  be  made: 

1.  Heredity  is  a  large  factor  in  unstable  mental  make-up,  although 
it  cannot  be  said  that  insanity  is  itself  really  hereditary. 

2.  Alcoholism  and  syphilitic  infection  are  definitely  responsible  for 
about  one-third  of  all  cases. 

3.  Bodily  disorders,  sometimes  seemingly  only  trivial,  but  often  of 
long  standing,  occur  in  the  history  of  a  great  many  patients. 

4.  Mental  peculiarities,  showing  themselves  long  before  the  insane 
condition  is  reached,  frequently  are  known. 

5.  In  a  considerable  number  of  cases  no  previous  indication  of 
approaching  disease  is  seen  and  at  present  no  satisfactory  ex- 
planation of  these  cases  can  be  made. 

PREVENTION  OF  INSANITY 


The  reader  who  has  followed  the  discussion  in  the  foregoing 
pages  is  already  in  possession  of  the  facts  and  theories  which  may 
now  be  employed  in  developing  a  program  for  prevention  of  insan- 
ity. Because  so  many  types  of  disease  are  called  by  the  one  name 
it  is  natural  that  many  different  methods  of  attacking  the  problem 
will  be  necessary.  Measures  which  seek  to  control  the  consumption 
of  alcoholic  liquors  do  not  apply  to  eradication  of  lead  poison  or 
of  arteriosclerosis.  Sanitary  and  safety  regulations  by  the  state, 
while  reducing  the  number  of  head  injuries,  can  have  little  influence 
on  auto-intoxication  or  heredity.  Since  two  causes  of  insanity  are 
thoroughly  understood — alcoholism  and  syphilis — the  first  point  of 
attack  in  controlling  insanity  should  be  an  attack  on  these  factors. 
Any  and  all  measures  which  may  aid  men  to  lead  temperate  and 
moral  lives  shculd  be  encouraged.  Facts  need  to  be  known  and 
appreciated.  It  should  be  understood,  for  example,  that  alcohol  is 
a  narcotic  and  anaesthetic,  not  a  true  "stimulant"  at  all — as  so 
many  believe.    The  pleasurable  feeling  induced  is  not  due  to  a  stim- 


EXTEN8I0X  BULLETIX.  13 

iilating  effect,  but  to  the  temporary  deadening  of  the  higher  nerve 
centers.  A  person  who  has  taken  a  drink  of  whiskey  no  longer 
appreciates  his  true  condition.  If  he  is  tired,  the  nervous  mechan- 
ism which  would  make  him  aware  of  the  fact  is  thrown '  otit  of 
gear  and  he  imagines  himself  refreshed  and  strengthened.  Btit  peo- 
ple attempting  to  work  under  the  "stimulus"  of  whiskey  do  their 
work  badly.  They  soon  tire  and  must  have  recourse  to  ever  increas- 
ing amounts  of  alcohol.  Another  matter  of  which  the  public  shotild 
know  more  is  the  danger  of  immoral  living.  "•  Sowing  wild  oats"  is 
hardly  the  trifling  fault  that  many  young  men  imagine.  There  is 
almost  a  certainty  of  contracting  venereal  disease.  Stich  disease 
is,  in  a  considerable  ntimber  of  cases,  followed  by  insanity — and 
syphilitic  insanity  is  incurable. 

Concerning  these  two  catises  of  insanity  mtich  can  be  done 
through  suitable  laws,  faithfully  enforced,  but  unless  the  ptiblic  is 
interested  in  enforcement,  the  laws  will  be  inoperative.  Education 
of  the  public  to  an  appreciation  of  the  great  menace  of  insanity 
should  encourage  a  right  public  sentiment.  It  is  a  disgrace  that  the 
states  should  be  called  upon  to  spend  great  sums  in  caring  for  pre- 
ventable cases  of  mental  disease. 

Such  insanity  as  is  associated  with  infectious  disease  shotild 
decrease  with  the  better  control  of  infections  by  health  depart- 
ments and  improved  methods  of  medical  treatment  and  nursing. 
If  auto-intoxication  is  involved,  changes  in  the  daily  life  of  the  in- 
dividual, leading  to  more  hygienic  living,  may  have  important  re- 
sults. Persons  troubled  with  constipation,  headaches,  or  kidney  dis- 
ease should  have  a  thorough  medical  examination  and  full  and  ra- 
tional treatment,  both  medical  and  hygienic.  Indeed,  any  one  suf- 
fering from  chronic  disease,  no  matter  how  seemingly  trivial,  ought 
to  secure  the  best  available  medical  advice  and  treatment. 

The  cultivation  of  proper  emotional  and  mental  states  is  highly 
desirable  in  every  one,  but  this  seems  especially  important  with 
those  of  psychopathic  make-up.  Whether  by  such  methods  alone 
a  threatened  attack  of  insanity  can  be  warded  off  is  difficult  of 
proof.  There  is,  however,  little  doubt  that  they  furnish  a  valuable 
adjuvant  to  hygienic  meastires.  More  attention  might  well  be  given 
in  the  home  to  proper  training  of  children  predisposed  to  nervous- 
ness. The  interested  reader  may  well  consult  Dr.  Barker's  little 
pamphlet  on  this  stibject,  mentioned  in  the  note  at  the  close  of  this 
paper. 


14  LXIVERSITY  OF  COLORADO. 

Most  of  the  insane  who  recover  at  all  do  so  within  a  few 
months  of  their  commitment  to  a  hospital.  Hence,  when  mental 
disease  is  detected  there  should  be  no  time  lost  in  applying  the 
best  methods  of  treatment.  It  is  of  great  importance  that  cases  be 
recognized  at  their  onset,  when  chances  of  recovery  are  best.  To 
accomplish  this  result  it  is  necessary  that  there  be  a  more  gen- 
eral knowledge  of  the  facts  of  insanity  and  of  the  possibility  of  cure. 
Voluntary  commitments,  although  rather  infrequent  now,  would  then 
become  more  common.  There  would  be  less  feeling  of  disgrace 
in  connection  with  mental  disease  and  a  better  and  more  healthy 
attitude  toward  those  who  have  recovered  from  an  attack. 

If  medical  schools  would  give  more  attention  to  mental  disease 
the  general  practitioner  would  be  able  at  an  early  period  to  recog- 
nize oncoming  insanity  in  his  patients.  By  this  means  many  cases 
which  are  now  allowed  to  progress  to  the  incurable  stage  might  be 
sent  promptly  to  a  suitable  hospital  and  recovery  be  made  possi- 
ble. Medical  students  would  find  a  thorough  course  in  psychology 
of  great  advantage  to  them. 

All  hospitals  for  the  insane  and  all  large  general  hospitals  might 
well  provide  special  clinics  or  dispensaries  for  psycopathic  cases. 
No  doubt  many  persons  who  fear  the  development  of  insanity  would 
go  to  such  clinics.  At  present  most  people  do  not  know  which 
way  to  turn  for  help. 

Courses  of  training  for  teachers  should  include  study  of  the 
principles  of  mental  hygiene  as  applied  to  the  training  of  children. 
This  would  seem  to  be  a  field  of  great  possibilities.  Indeed,  a 
knowledge  of  personal  hygiene  in  all  its  branches  is  highly  desirable 
in  the  teacher. 

Universities  and  colleges  may  contribute  much  to  the  preven- 
tion of  insanity  through  scientific  investigation;  also  by  offering 
courses  in  hygiene  to  undergraduates.  There  needs  to  be  a  wide- 
spread knowledge  of  how  to  keep  in  good  health.  Measures  which 
have  been  found  of  value  in  the  prevention  of  tuberculosis  will  un- 
doubtedly prove  useful  in  protecting  from  nervous  and  mental  dis- 
orders. The  importance  of  sunlight,  fresh  air,  good  food  and  mod- 
erate exercise  can  hardly  be  overestimated.  If  the  "intelligent  pub- 
lic" could  be  made  really  intelligent  as  to  health-preservation,  a 
large  part  of  the  insanity  problem  would  be  solved. 

The  work  of  prevention  of  insanity  should  not  and  cannot  be 
thrown  entirely  upon  the  state.     At  any  rate  the  acts  of  the  state 


EXTENSIOX  BULLETIX.  15 

must  always  rest  upon  public  opinion.  Intelligent  public  opinion 
can  have  its  foundation  only  in  accurate  knowledge.  The  follow- 
ing are  adapted  from  a  set  of  suggestions  made  by  the  National 
Committee  on  Mental  Hygiene: 

1.  Let  every  one  become  informed  as  to  tbe  causes  of  mental  dis- 
ease and  make  the  facts  known  to  others. 

2.  Let  each  lead  a  hygienic  life,  physically,  mentally,  and  morally. 

3.  Let  all  speak  and  think  of  insanity  as  a  disease;  not  as  a 
crime.  No  family  should  feel  disgraced  because  some  member 
hecomes  insane. 

4.  If  relative,  friend  or  acquaintance  seems  to  be  in  poor  health 
physically  or  mentally,  let  him  be  informed  of  the  value  of 
prompt  medical   care. 

5.  When  philanthropists  or  hospital  superintendents  ask  for  im- 
proved facilities  for  the  detection  and  treatment  of  insanity,  let 
every  intelligent  person  lend  his  aid. 

While  it  is  seldom  safe  to  prophesy  there  seems  good  reason  to 
hope  for  a  decrease  of  insanity  in  the  coming  years.  Many  forces 
are  at  work  which  make  for  temperance,  morality,  intelligence,  and 
hygienic  living.  These  should  bring  about  in  time  a  better  average 
condition  of  both  physical  and  mental  health. 

Note  :  The  following'  three  are  excellent  popular  works  on  personal 
hygiene.  (The  last  two  have  well-written  chapters  on  the  nervous  sys- 
tem) : 

HrxcHixsox,  "Woods..  The  Conquest  of  Consumption,  Boston,    1910. 

Ptle,  TV  alter  L..,   Personal  Hygiene;    Philadelphia,    1907. 

WooDWORTH,  R.  S.,  The  Care  of  the  Body;  Xew  York,  1912. 

TVorks  dealing  with  insanity  are  chiefly  technical  and  quite  beyond 
the  understanding  of  the  ordinary  reader.  The  following,  are,  however, 
not  only  readable,  but  highly  interesting  : 

Beers^  Clifford  TV.,  A  Mind  that  Found  Itself;   New  York.  1912. 

Hart^  Berxard^  The  Psychology-  of  Insanity;    Cambridge,-  Eng.,   1912. 

The  National  Committee  on  Mental  Hygiene  has  issued  a  number  of 
pamphlets  which  may  be  secured  on  application  to  the  Secretary  of  the 
committee  at  50  Union  Square,  New  York  City.     Following-  are  the  titles: 

No.  1.  Origin,  Objects  and  Plans  of  the  National  Committee  for 
Mental  Hygiene  ;  the  mental  hygiene  movement ;  state  societies  ;  informa- 
tion  regarding  the   problem  of  mental  health  and  the  care   of  the  insane. 

No.  2.  Principles  of  Mental  Hygiene  applied  to  the  Management  of 
Children  predisposed  to  nervousness.  By  Dr.  Lewellys  F.  Barker.  (Is- 
sued March,  1912.)  [This  is  an  exceedingly  valuable  paper  for  parents 
and  teachers.] 

No.  3.  Summaries  of  the  Laws  relating-  to  the  Commitment  and  Care 
of  the  Insane  in  the  United  States,  compiled  by  John  Koren.  Price,  ?1.00. 
(Issued  September,   1912.) 

No.  4.  Some  Phases  of  the  Mental  Hygiene  Movement  and  the  Scope 
of  the  Work  of  the  National  Committee  for  Mental  Hygiene.  By  Lewellys 
F.   Barker.      (Issued  November,   1912.) 


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